Insertion system for corneal implants

ABSTRACT

Provided therein are apparatuses, systems and methods for storing and retrieving a corneal implant and for delivering the corneal implant in or on the cornea. In an embodiment, a insertion system comprises an inserter for delivering a corneal implant to a desired location in or on the cornea. The inserter has a holding space at its distal end for holding a corneal implant therein. A solution may substantially fill the holding space with the corneal implant to keep the implant hydrated and to hold the implant in the holding space by the surface tension of the solution. The corneal implant may be preloaded in the holding space of the inserter and stored in a storage container filled with storage fluid, e.g., saline, until use. To deliver the corneal implant, the inserter is positioned at the desired location, and the corneal implant released from the holding space of the inserter.

FIELD OF THE INVENTION

The field of the invention relates generally to corneal implants, andmore particular, to insertion systems for corneal implants.

BACKGROUND INFORMATION

As is well known, abnormalities in the human eye can lead to visionimpairment. Some typical abnormalities include variations in the shapeof the eye, which can lead to myopia (near-sightedness), hyperopia(far-sightedness) and astigmatism as well as variations in the tissuepresent throughout the eye, such as a reduction in the elasticity of thelens, which can lead to presbyopia. A variety of technologies have beendeveloped to try and address these abnormalities, including cornealimplants.

Corneal implants can correct vision impairment by altering the shape ofthe cornea. Corneal implants can be classified as an onlay or an inlay.An onlay is an implant that is placed over the cornea such that theouter layer of the cornea, e.g., the epithelium, can grow over andencompass the implant. An inlay is an implant that is surgicallyimplanted into the cornea beneath a portion of the corneal tissue by,for example, cutting a flap in the cornea and inserting the inlaybeneath the flap. Both inlays and outlays can alter the refractive powerof the cornea by changing the shape of the anterior cornea, by having adifferent index of refraction than the cornea, or both. Since the corneais the strongest refracting optical element in the human ocular system,altering the cornea's anterior surface is a particularly useful methodfor correcting vision impairments caused by refractive errors.

There is a need for improved apparatuses, systems and methods forstoring a corneal implant prior to use and for retrieving the cornealimplant from storage during a surgical procedure. There is also a needfor improved apparatuses, systems and methods for delivering a cornealimplant to the cornea and for precisely depositing the corneal implantat a desired location in or on the cornea without damaging the cornealimplant.

SUMMARY

Provided herein are apparatuses, systems and methods for storing andretrieving a corneal implant and for delivering the corneal implant inor on the cornea.

In an embodiment, an insertion system comprises an inserter fordelivering a corneal implant to a desired location in or on the cornea.The inserter comprises an elongated body having a distal end and aproximal end. The elongated body has a holding space at its distal endfor holding the corneal implant to be delivered. The holding space isformed between a top distal portion and a bottom distal portion of theelongated body. In a preferred embodiment, a solution, e.g., saline,substantially fills the holding space with the corneal implant to keepthe implant hydrated and to hold the implant in the holding space by thesurface tension of the solution. The elongated body of the inserter mayalso have a curved portion that follows the curvature of the cornea anda clearance bend that provides clearance between the inserter and afacial feature, e.g., nose, of the patient.

In an embodiment, the corneal implant is preloaded in the holding spaceof the inserter and the preloaded inserter is stored in a storagecontainer filled with storage fluid, e.g., saline, until use. In oneembodiment, a cap is placed on the distal end of the inserter after theimplant is preloaded. The cap encloses the holding space of the inserterto prevent the corneal implant from moving out of the holding space inthe storage fluid during storage. By preloading the implant in theinserter, the surgeon does not have to separately retrieve the implantand place the implant in the inserter, which is difficult due to thesmall size and delicate nature of the implant.

A method of delivering a corneal implant according to an embodimentincludes positioning an inserter with the corneal implant at a desiredlocation in or on the cornea. At the desired location, the cornealimplant is held down in the holding space of the inserter by a surgicaltool, e.g., cannula. The surgical tool accesses the implant in theholding space through a slot in the inserter. While the corneal implantis held down by the surgical tool, the inserter is retracted to releasethe corneal implant from the inserter and deposit the corneal implant atthe desired location. By holding down the implant at the desiredlocation and retracting the inserter to release the implant, the surgeonis able to precisely deposit the implant at the desired location.

Other systems, methods, features and advantages of the invention will beor will become apparent to one with skill in the art upon examination ofthe following figures and detailed description. It is intended that allsuch additional systems, methods, features and advantages be includedwithin this description, be within the scope of the invention, and beprotected by the accompanying claims. It is also intended that theinvention not be limited to the details of the example embodiments.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows a perspective view of an insertion system comprising aninserter and a cap according to an embodiment of the present invention.

FIG. 2 shows a perspective view of the cap placed on the inserteraccording to an embodiment of the present invention.

FIG. 3 shows a side view of the distal end of the inserter according toan embodiment of the present invention.

FIG. 4 shows a close-up perspective view of the distal end of theinserter according to an embodiment of the present invention.

FIG. 5A shows the inserter depositing a corneal implant on the corneaaccording to an embodiment of the present invention.

FIG. 5B shows a close-up of the inserter depositing the corneal implanton the cornea.

FIG. 5C shows the inserter depositing a corneal implant on an interiorsurface of the cornea exposed by forming a flap in the cornea accordingto an embodiment of the invention.

FIG. 5D shows the inserter depositing a corneal implant within a pocketformed in the cornea according to an embodiment of the presentinvention.

FIG. 6 shows the inserter and cap stored in a container filled withstorage fluid according to an embodiment of the present invention.

FIG. 7 shows a perspective view of the inserter with a luer lockattached to the proximal end of the inserter according to an embodimentof the present invention.

FIG. 8 shows a perspective view of the inserter with a syringe connectedto the proximal end of the inserter according to an embodiment of thepresent invention.

FIG. 9 shows a perspective view of an inserter according to anotherembodiment of the present invention.

FIG. 10 shows a back view of the distal end of the inserter according toan embodiment of the present invention.

FIG. 11 shows the inserter depositing a corneal implant on the corneaaccording to an embodiment of the present invention.

DETAILED DESCRIPTION

FIGS. 1-5 show an insertion system according to an embodiment that isparticular suited for delivering a corneal implant, e.g., inlay, in oron the cornea. The insertion system is also suited for storing theimplant prior to its use. The insertion system includes an inserter 100having an elongated body, which may be made of titanium, stainlesssteel, plastic, or other biocompatible material. The inserter 100comprises a distal portion having generally flat top and bottomsurfaces. The distal portion of the inserter 100 includes a clearancebend 104 where the inserter is bent to provide clearance between theinserter and a patient's facial features (e.g., nose, cheeks, etc.) asexplained further below. The distal portion of the inserter 100 alsoincludes a curved portion 103 that is contoured to follow the shape of apatient's cornea as explained further below. The curved portion 103 isconcaved on the bottom surface of the inserter 100.

The inserter 100 further includes a holding space 101 for holding acorneal implant 200 to be delivered by the inserter. Preferably, saline,BSS or other solution (not shown) is placed in the holding space 101 tohold the implant 200 therein due to surface tension of the saline. Thesaline stays in the holding space 101 due to capillary forces, therebykeeping the implant hydrated. The inserter also includes top and bottominserter slots 102 and 110 as shown in FIG. 4. As explained below, theinserter slots 102 and 110 allow a surgeon to view the patient's corneathrough the slots for precise placement of the implant 200. In addition,the top inserter slot 102 allows the surgeon to hold down the implant200 in the holding space 101 at a desired position while the surgeonretracts the inserter 100 to release the implant 200. The surgeon mayhold down the implant 200 with a surgical tool, such as a cannula,Sinskey hook or other tool that can fit through the top inserter slot102. The top inserter slot 102 extends to the leading edge 111 of theinserter 100 so that the tool can hold down the implant 200 as theinserter 100 is retracted. The leading edge 111 of the inserter ispreferably rounded to prevent damage to the cornea.

In the preferred embodiment, the width “w” of the holding space 101 isslightly larger than the diameter of the implant 200 to be delivered bythe inserter 100 as shown in FIG. 3. In an exemplary embodiment, theimplant 200 has a diameter of about 1.5 mm and the width “w” of theholding space 101 is between 1.6 and 1.7 mm. The rounded leading edge111 of the inserter 100 follows the perimeter of the implant 200. Thecenter length “1” of the holding space 101 is slightly larger than thediameter of the implant 200. As shown in FIG. 3, the center length “I”extends from the center of the leading edge 111 to the back wall 113 ofthe holding space 101. The geometry of the holding space 101 and thesurface tension of the saline in the holding space 101 keep the implant200 substantially centered in the inserter 100. The height of theholding space 101 may be several times larger than the center thicknessof the implant 200 to ensure that enough saline is in the holding space101 to keep the implant sufficiently hydrated.

The inserter 100 may be manufactured from a rod that is cut and bent toform the inserter 100. In one embodiment, a cylindrical titanium rod iscut and bent to form the inserter 100. In this embodiment, the proximalportion of the inserter 100 is generally cylindrical with angledportions that taper down to the distal portion of the inserter 100.

The inserter system further includes an inserter cap 300, which may bemade of Teflon (PTFE). In an embodiment, the inserter cap 300 isgenerally cylindrical and can be fitted snugly on the distal end of theinserter 100 by engaging the sides of the inserter 100 as shown in FIG.2.

In a preferred embodiment, the implant 200 is preloaded in the inserter100 and packaged for later use by the surgeon during an implantationprocedure. In this embodiment, the implant is 200 preloaded into theholding space 101 of the inserter 100 with the top surface of theimplant 200 orientated to face the top surface of the inserter 100. Theimplant 200 may be preloaded by submerging both the implant 200 and theholding space 101 of the inserter 100 in a solution, e.g., saline, andinserting the implant 200 into the holding space 101 while they are bothsubmerged. After the implant 700 is preloaded in the inserter 100, theinserter cap 300 is placed on the distal end of the inserter 100. Thecap 300 may be placed on the inserter 100 while the holding space 101 isstill submerged in the solution. The preloaded inserter 100 assembledwith the inserter cap 300 is placed into a vial 400 or other storagecontainer filled with saline 410 or other suitable solution as shown inFIG. 6. The inserter cap 300 prevents the implant 200 from moving out ofthe inserter 100 when placed in the vial 400 filled with saline 410. Thevial 400 is capped and placed in an outer package 420, which issterilized to store the insertion system until use.

An implantation procedure using an insertion system according to anembodiment will now be given. In this embodiment, the preloaded inserter100 is removed from the outer package 420 and the vial 400 filled withsaline 410. The saline within the space between the inserter cap 300 andthe inserter 101 is then removed by placing a sterile surgical sponge(not shown) or other absorbent material on the open end on the insertercap 300. The sponge draws out the saline from the interior of the cap300 by capillary action through the opening between the cap 300 and theinserter 101. In the embodiment in which the cap 300 has a generallycylindrical shape, the opening is formed between the cylindrical cap 300and the flat top and bottom surfaces of the inserter 100. The saline isremoved from the spaced between the cap 300 and the inserter 100 whilethe cap 300 is still on the inserter 100. This is done to prevent thecap 300 from pulling the implant 200 out of the inserter 100 bycapillary action when the cap 300 is removed from the inserter 100.After the saline is removed, the cap 300 is removed from the inserter100. At this point, a small amount of saline or BSS may be applied tothe holding space 101 of the inserter 100 to keep the implant 200hydrated. The saline stays in the holding space 101 due to capillaryforces, thereby keeping the implant 200 hydrated during the procedure.Further, the surface tension of the saline holds the implant 200 in theholding space 101 of the inserter 100 so that the implant 200 does notfall out of the inserter 100 during the procedure. This surface tensionand the geometry of the holding space 101 keep the implant 200 centeredin the inserter 100. To enable a surgeon to better hold the inserter100, a handle 500 may be attached to the proximal end of the inserter100 as shown in FIG. 5A. The handle may be similar to handles thatattach to disposable blades. Further, the surgeon may determine theproper orientation of the implant based on features of the inserter 100.For example, when the top of the inserter 100, and hence the implant200, are facing upward, the concaved bottom surface of the curvedportion 103 of the inserter 100 is facing downward.

The surgeon may then implant the corneal implant 200 in the patient'scornea. To access the interior of the cornea, a flap may be cut into thecornea and lifted to expose the cornea's interior, e.g, stroma bed ofthe cornea. An example of this is shown in FIG. 5C, in which a flap 1120is cut into the cornea 600 and pulled backed to expose the stroma bed1100 of the cornea. The flap 1120 is attached to the cornea 600 by aflap hinge 1110. The flap 1120 may be cut using a laser, e.g.,femtosecond laser, a mechanical keratome or manually. Several methodsfor forming flaps in corneal tissue, and other related information, aredescribed in further detail in co-pending U.S. patent application Ser.No. 10/924,152, filed Aug. 23, 2004, entitled “Method for KeratophakiaSurgery,” which is fully incorporated by reference herein. Once theinterior is exposed, the surgeon positions the inserter 100 so thatimplant 200 is at the desired location on the cornea 600, e.g., thepatient's pupil or visual axis as shown in FIG. 5A. Prior to positioningthe inserter 100, the surgeon may use a surgical sponge to remove excessfluid on the outer surface of the inserter 100 being careful not toremove the saline from the holding space 101. The clearance bend 104allows the inserter to clear the patient's facial features (e.g., nose)as the surgeon manipulates the inserter 100. To precisely position theimplant 200 the surgeon may view the cornea 600 through the inserterslots 102 and 110 and the implant 200, which is transparent. When theimplant 200 is at the desired location, the surgeon holds down theimplant 200 on the cornea 600 using a surgical cannula, Sinskey Hook orother tool 610 such that implant 200 gently touches the stroma bed ofthe cornea 600 through the bottom slot 110. This tool 610 holds down theimplant 200 through the top inserter slot 102 as shown in FIG. 5B. Thesurgeon then retracts the inserter 100 from the cornea 600 to releasethe implant 200 from the inserter 100 and deposit the implant 200 at thedesired location. If the implant 200 is not precisely at the desiredlocation, then the surgeon may gently move the implant 200 into positionusing a surgical sponge, rounded-tip tool, or other tool. In the exampleshown in FIG. 5C, the implant 200 is centered on the patient's pupil1130. After the implant 200 is correctly positioned, the surgeon placesthe flap 1120 over the implant 200.

The implant 200 may be implanted concurrent with a LASIK procedure orpost-LASIK. Since a flap is cut into the cornea during a LASIKprocedure, the same flap may be used to implant the implant 200. If theimplant 200 is implanted post-LASIK, then the LASIK flap may bere-opened or the inserter 100 may be advanced between the flap and theunderlying corneal tissue to the desired position. In this example, theLASIK procedure may be used to correct distance vision while the implantis used to provide near vision. Additional details can be found, forexample, in U.S. patent application Ser. No. 11/554,544, entitled “SmallDiameter Inlays,” filed on Oct. 30, 2006, the specification of which isincorporated herein by reference.

The implant 200 may also be implanted through a closed flap instead ofan open flap. In this embodiment, the distal portion of the inserter 100may be inserted between the flap and the underlying corneal tissue andadvanced between the flap and underlying corneal tissue to the desiredposition in the cornea. The distal portion of the inserter 100preferably has a thin cross-section so that the inserter 100 does notinduce corneal wound stretching. The curved portion 103 of the inserter100 follows the curvature of the cornea allowing the inserter to moreeasily move between the flap and underlying corneal tissue whileminimizing stress on the cornea. Further, the top surface of theinserter 100 preferably a downward slopping portion 115 that slopesdownward to the leading edge 111 of the inserter 100 as shown in FIG. 3.In this embodiment, a surgical cannula or other tool may also beinserted between the flap and the underlying corneal tissue to hold downthe implant 200 at the desired location and release the implant 200 fromthe inserter 100.

The implant 200 may also be implanted using different methods to accessthe interior of the cornea. For example, the interior of the cornea maybe accessed through a lamellar pocket, channel, or pathway cut into thecornea. Additional details may be found, for example, in U.S. patentapplication Ser. No. 11/421,597, entitled “Ocular Tissue SeparationAreas With Barrier Regions For Inlays Or Other Refractive Procedures, ”filed on Jun. 1, 2006, the specification of which is incorporated hereinby reference. Methods for creating pockets in the cornea are describedin United States Patent Application Publication No. 2003/0014042,published Jan. 16, 2003, entitled “Method of Creating Stromal Pocketsfor Corneal Implants,” which is also fully incorporated by referenceherein. For example, the inserter may be inserted into a channel orpocket cut into the cornea and advanced through the channel to positionthe implant at the desired location in the cornea. A second channel mayalso be cut into the cornea to provide access for the surgical cannulaor other tool used to hold down the implant at the desired location. Apocket is a recess formed within the corneal tissue for receiving thecorneal implant and may be accessed through a channel formed in thecornea. FIG. 5D shows an example of the inserter 100 placing the implant200 within a pocket 700 in formed in the cornea 600 through an opening710.

In another embodiment, the inserter 100 may include a channel runningthrough the inserter 100 and extending from the proximal end of theinserter 100 to the holding space 101. The proximal end of the inserter100 may be connected to a syringe filled with fluid, e.g., saline, fordelivering fluid to the holding space 101 through the channel. In thisembodiment, the channel may deliver fluid at the back of the holdingspace 101. This allows a surgeon to deliver a small amount of fluid intothe holding space 101 to hydrate the implant 200 and/or gently push theimplant 200 out of the holding space 101 for releasing the implant 200from the inserter 100. For example, when the implant 200 is at thedesired location on the cornea, the surgeon may deliver fluid throughthe channel to help release the implant 200 from the inserter 101. Thismay be done instead of or in conjunction with the tool used to hold downthe implant 200. FIG. 7 shows an inserter 100 according one embodimentcomprising a luer lock 810 at the proximal end of the inserter 100 thatis configured to mate with a corresponding luer lock of a syringe orother fluid delivering device. FIG. 8 shows an embodiment in which asyringe 820 is connected to the proximal end of the inserter 100 via theluer lock 810 for delivering fluid through the channel.

FIGS. 9 and 10 show a distal portion of an inserter 900 according toanother embodiment. In this embodiment, the inserter 900 comprises acannula 910 or tube configured to hold the implant 1000 therein fordelivery to the cornea. The cannula 910 preferably has a width slightlylarger than the width of the implant 1000 to be delivered by theinserter 900. The cannula 910 also preferably has a height that isslightly larger than the thickness of the implant 1000. The distal end920 of the cannula 910 is preferably shaped to hold the implant 1000 inan unstressed state. The cannula 910 may be slightly curved along itswidth and/or length to follow the curvature of the cornea. Fluid, e.g.,saline or BSS, may be delivered to the implant 1000 through a channel inthe inserter 900 to ensure that the implant 1000 is hydrated prior touse and/or to release the implant 1000 from the inserter 900.

The inserter 900 also includes a top inserter slot 930 through which asurgical cannula, Sinskey Hook or other tool can be used to hold downthe implant 1000 at the desired location in the cornea. The inserter 900also includes a bottom opening 940 through which the implant 1000 cancontact the cornea when the implant is held down as shown in FIG. 10.Preferably, the edges and corners at the tip of the cannula 910 aresmooth and rounded to prevent cutting by the cannula 910 and damage tothe cornea or implant from the tip of the cannula. A handle may beattached to the proximal end of the inserter for easier handling by thesurgeon. Further, a syringe or other fluid delivering device may beconnected to the inserter 900 for delivering fluid to the implantthrough the channel in the inserter 900. FIG. 11 shows the entireinerter 910, which includes a clearance bend 945 and an elongatedportion 950 with an optional luer lock 960 at the proximal end of theinserter 910 for connecting, e.g., a fluid delivering device to theinserter 910.

The implant 1000 may be implanted in the cornea using procedures similarto the ones discussed above. For example, a flap may be cut into thecornea and lifted to expose a stroma bed of the cornea. The surgeon maythen position the implant 1000 at the desired location using theinserter 900. When the implant 1000 is at the desired position, thesurgeon may use a surgical cannula or other tool to hold the implant1000 through the top inserter slot 930. The surgeon may hold down theimplant 1000 such that the bottom surface of the implant 1000 contactsthe cornea through the bottom opening 940 of the inserter 900. While theimplant 1000 is held down at the desired location, the surgeon retractsthe inserter 900 to deposit the implant 1000 on the cornea. The surgeonmay also deliver fluid to the implant 1000 through the channel in theinserter to release the implant 1000 from the inserter 900. After theimplant 1000 is correctly positioned, the surgeon places the flap overthe implant 1000. FIG. 11 shows an example of the inserter 900positioned over the desired location of the cornea for depositing theimplant 1000 at the desired location.

The implant 1000 may also be implanted using other procedures includingimplantation through a channel, pocket or pathway cut into the corneafor access to the desired position in the cornea. In these procedures,the inserter 900 may be moved to the desired position through thechannel, pocket or pathway. The thin cross section of the inserter 900minimizes stress on the cornea as the inserter 900 is advanced throughthe channel, pocket or pathway. A second channel may also be cut intothe cornea to provide access for the surgical tool used to hold down theimplant 1000 at the desired location.

The inserter systems described herein may to used to implant varioustypes of corneal implant. For example, the inserter systems may be usedto implant corneal implants deep within the cornea such as intraocularlenses or at lower depths such as inlays. The inserter systems may alsobe used to place an onlay on the surface of the cornea. Thus, theinserter systems may be used to implant corneal implants of variousrigidity, sizes and properties at various depths in the cornea. Thecorneal implant may be an inlay, lens, or the like.

In the foregoing specification, the invention has been described withreference to specific embodiments thereof. It will, however, be evidentthat various modifications and changes may be made thereto withoutdeparting from the broader spirit and scope of the invention. As anotherexample, each feature of one embodiment can be mixed and matched withother features shown in other embodiments. As yet another example, theorder of steps of method embodiments may be changed. Features andprocesses known to those of ordinary skill may similarly be incorporatedas desired. Additionally and obviously, features may be added orsubtracted as desired. Accordingly, the invention is not to berestricted except in light of the attached claims and their equivalents.

1. An insertion system for a corneal implant comprising: an elongatedbody having a distal end and a proximal end; a holding space at thedistal end of the elongated body configured to hold a corneal implanttherein, wherein the holding space is defined between a top distalportion and a bottom distal portion of the elongated body; and a slotthrough the top distal portion of the elongated body, wherein the slotextends to a leading edge of the elongated body.
 2. The insertion systemof claim 1, wherein the holding space has a width that is no more than20 percent larger than a diameter of the corneal implant to be deliveredby the inserter.
 3. The insertion system of claim 1, wherein the topdistal portion of the elongated body slopes downward to the leadingedge.
 4. The insertion system of claim 1, wherein the leading edge issemicircular.
 5. The insertion system of claim 1, further comprising abottom slot through the bottom distal portion of the elongated body. 6.The insertion system of claim 5, wherein the bottom slots extends to theleading edge of the elongated body and is substantially aligned with theslot through the top distal portion.
 7. The insertion system of claim 1,wherein the elongated body is made from a single piece of material. 8.The insertion system of claim 7, wherein the material comprisestitanium.
 9. The insertion system of claim 1, wherein the elongated bodyhas a curved portion near the distal end.
 10. The insertion system ofclaim 9, wherein the curved portion of the elongated body substantiallymatches a curvature of a cornea.
 11. The insertion system of claim 9,wherein the elongated body has a bent portion proximal to the curvedportion.
 12. The insertion system of claim 1, further comprising achannel running through the elongated body and extending from theholding space to the proximal end.
 13. The insertion system of claim 12,further comprising a luer lock attached to the proximal end of theelongated body for connecting the channel to a fluid delivering device.14. The insertion system of claim 1, further comprising a cornealimplant held within the holding space of the elongated member.
 15. Theinsertion system of claim 14, wherein the corneal implant has a diameterof between 1 mm and 7 mm.
 16. The insertion system of claim 15, whereinthe holding space has a width that is no more than 20 percent largerthan a diameter of the corneal implant.
 17. The insertion system ofclaim 14, further comprising a cap placed on the distal end of theelongated body, wherein the cap substantially encloses the holding spaceof the elongated body.
 18. The insertion system of claim 17, furthercomprising a storage container at least partially filled with a fluid,wherein the cap and the holding space of the elongated body aresubmerged in the fluid.
 19. The insertion system of claim 18, whereinthe fluid comprises saline.
 20. A method of delivering a corneal implantcomprising forming a site on or in the cornea for receiving the cornealimplant; positioning a distal end of an inserter at the site, the distalend of the inserter comprising a holding space with a corneal implanttherein, wherein the holding space is defined between a top distalportion and a bottom distal portion of the elongated body; removing thecorneal implant from the holding space of the inserter; and depositingthe corneal implant on or in the cornea at the site.
 21. The method ofclaim 20, wherein the inserter further comprises a slot through the topdistal portion and extending to a leading edge of the inserter, themethod further comprising: holding down the corneal implant in theholding space with a surgical tool through the slot; and retracting theinserter from the cornea to deposit the corneal implant on or in thecornea.
 22. The method of claim 20, further comprising: forming a flapin the cornea; lifting the flap to expose a corneal bed; depositing thecorneal implant on the corneal bed; and placing the flap over thecorneal implant on the corneal bed.
 23. The method of claim 20, furthercomprising: forming a channel in the cornea to the site; and advancingthe distal end of the inserter through the channel to access the site.24. The method of claim 20, further comprising: forming a pocket withinthe cornea to receive the corneal implant; and advancing the distal endof the inserter to the pocket.
 25. The method of claim 20, wherein theholding space with the corneal implant is substantially filled with asolution, wherein surface tension of the fluid holds the corneal implantin the holding space.
 26. The method of claim 25, wherein the solutioncomprises saline.